What is the clinical evidence from this study?

Study design: Cross-Sectional. Population: Major depressive disorder (n=92). Intervention: Major depressive disorder vs. Non-depressed controls. Primary outcome: Standard deviation of normal-to-normal intervals (SDNN) (p=<0.001).

July 1, 2026Open Access

Interplay of physical activity and sleep in modulating heart rate variability: insights from adults with major depressive disorder

Q: What are the key findings of this study?

Adults with major depressive disorder demonstrated markedly reduced heart rate variability, including a lower SDNN (

ABArijita BanerjeeIndian Institute of Technology Kharagpur SKSumit KumarKing George's Medical University

Key Result

Adults with major depressive disorder demonstrated markedly reduced heart rate variability, including a lower SDNN (

Study Design

Type

Cross-Sectional (n=92)

Multicenter

Structured PICO

Does Major Depressive Disorder, along with poor sleep and physical inactivity, reduce heart rate variability in young adults?

Population

92 adults aged 18-45 years, comprising 46 with DSM-5-TR confirmed major depressive disorder and 46 matched non-depressed controls, assessed cross-sectionally for heart rate variability, sleep quality, and physical activity.

Exposure

Major Depressive Disorder (MDD) diagnosis (unmedicated current major depressive episode)

Comparator

Non-depressed healthy controls, frequency-matched for age and sex, with PHQ-9 < 10 and no history of mood or anxiety disorders

Outcome

Heart rate variability (HRV) parameters including time-domain (SDNN, rMSSD, pNN50), frequency-domain (LF, HF, LF/HF ratio), and Poincare plot indices (SD1, SD2, SD1/SD2 ratio) measured via 5-minute resting ECGsurrogate

Young adults with unmedicated major depressive disorder exhibit significant cardiac autonomic dysregulation, which is further exacerbated by poor sleep quality and physical inactivity.

Main Result

Absolute Event Rate: 39.2% vs 58%

p-value: p=<0.001

Abstract

Background: Major depressive disorder (MDD) is a leading contributor to global disability and is increasingly recognised as a significant cardiovascular risk factor mediated through autonomic nervous system (ANS) dysregulation. Methods: This cross-sectional comparative study investigated associations between sleep quality, physical activity, and heart rate variability (HRV) including Poincare plot indices (SD1, SD2, SD1/SD2 ratio) in 46 adults with Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR) confirmed MDD versus 46 non-depressed controls (aged 18-45 years) recruited at the Dr BC Roy Multi-Speciality Medical Research Centre, IIT Kharagpur, India. Results: MDD participants demonstrated markedly reduced HRV across all domains: SDNN (39.2 ± 14.8 vs 58.0 ± 18.6 ms), rMSSD (27.4 ± 12.6 vs 46.2 ± 15.4 ms), SD1 (19.4 ± 8.8 vs 32.6 ± 11.2 ms), SD2 (52.2 ± 18.6 vs 77.4 ± 21.8 ms), and high-frequency power (5.36 ± 0.88 vs 6.56 ± 0.80 ln ms²; all p < 0.001). Poor sleep quality (PSQI ≥ 7) was significantly more prevalent in MDD (82.6% vs 47.8%). PSQI scores were independently associated with reduced HRV in multivariable regression, with associations substantially stronger in MDD participants and particularly in females with MDD. Physical inactivity amplified sleep-related HRV decrements. Conclusion: These cross-sectional findings are consistent with the hypothesis that comprehensive HRV assessment, systematic sleep quality screening, and structured physical activity promotion may be beneficial components of MDD management, pending confirmation from longitudinal interventional studies.

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